International Journal of
Environmental Research
and Public Health
Article
Body-Esteem, Self-Esteem and Loneliness among Social Media
Young Users
Lavinia Maria Pop 1 , Magdalena Iorga 1,2, *
Citation: Pop, L.M.; Iorga, M.; Iurcov,
R. Body-Esteem, Self-Esteem and
Loneliness among Social Media
Young Users. Int. J. Environ. Res.
Public Health 2022, 19, 5064. https://
doi.org/10.3390/ijerph19095064
Academic Editor: Paul B.
Tchounwou
Received: 19 March 2022
Accepted: 19 April 2022
Published: 21 April 2022
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4.0/).
Int. J. Environ. Res. Public Health 2022, 19, 5064. https://doi.org/10.3390/ijerph19095064
and Raluca Iurcov 3
1 Faculty of Psychology and Education Sciences, “Alexandru Ioan Cuza” University of Iasi,
700554 Iasi, Romania; lavinia-maria.pop@umfiasi.ro
2 Behavioral Sciences Department, “Grigore T. Popa” University of Medicine and Pharmacy,
700115 Iasi, Romania
3 Dentistry Department, Faculty of Medicine, University of Oradea, 410073 Oradea, Romania;
riurcov@uoradea.ro
* Correspondence: magdalena.iorga@umfiasi.ro
Abstract: The use of social networking sites for socializing, having fun, solving academic tasks
or even getting counselling for health-related problems is now inevitable. Methods: A total of
427 medical students, who are users of social media sites, were included in the research. Data about
socio-demographic, anthropometric, and self-rated items regarding satisfaction with physical and
mental health were collected. Three psychological tools were also used to measure self-esteem
(Rosenberg Self-Esteem Scale), body-esteem (Body Esteem Scale for Adolescents and Adults) and loneliness
(UCLA Loneliness Scale). Collected data were analyzed using SPSS version 23. Results: Students use
these networks for socialization (49.0%), entertainment (31.1%) and academic tasks (19.9%), spending
3.38 ± 0.80 h per day on SNSs. Less than half of them (47.5%) compared themselves to other SNS
profiles. The use of Snapchat was found to be strongly positively correlated with self-esteem, and
weight status was negatively correlated with the use of TikTok. More than three-quarters declared
that they exercised to lose weight or to prevent weight gain. Participants were found to have a
high level of body esteem. Almost half of the students proved to have a moderate to a high level
of loneliness. Age and gender were found to be important: the younger the user, the higher the
scores for loneliness and feeling depressed, and the greater the number of hours on SNSs. The total
score for self-esteem was significantly higher in men than in women, and male students appreciated
themselves as being in a better state of mental health than women. Conclusions: The results prove a
relationship between the use of SNSs and the presence of loneliness, self-esteem and body-esteem,
with gender differences. However, the use of SNSs should not be neglected in clinical settings, and
are a good means of reaching patients and providing medical and psychological intervention.
Keywords: body image; body mass index; body esteem; loneliness; self-esteem; young adults;
medical students; social network; health
1. Introduction
In a world that is constantly connected, in which individuals from different cultures
and who speak different languages can relate and find common goals of communication,
identifying the degree of loneliness among these individuals, especially for those at an age
when social relationships are strongly stimulated, seems like a paradox.
One area of Internet usage that has become increasingly popular is the use of social
networking sites (SNSs). Data provided by Social Networking Fact Sheets, in 2015, showed
that 74% of online adults were using SNSs [1]. A growing body of scientific literature has
explored the association between general social networking site (SNS) use and loneliness,
although results have not clarified whether SNS use increases or decreases loneliness. There-
fore, SNS use has been related not only to greater social connectedness and wellbeing [2],
but also to increased loneliness [3].
https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022, 19, 5064 2 of 14

In contemporary society, numerous young people move away from their personal
networks for extended periods to achieve professional and/or educational goals. This
separation can often lead to feelings of loneliness, which can be stressful for the
individual [4].
Loneliness is a subjective psychological state, and has been associated with objective
social isolation, depression, introversion or poor social skills. Loneliness is defined as a
unique condition in which an individual perceives himself or herself to be socially isolated
even when among other people [5]. It has been found to steadily increase with age and,
almost consistently, to be strongly associated with poor health conditions and unfavorable
behaviors across all ages. It has also been found to be far more prevalent in today’s society
than in previous generations [6]. Loneliness has been shown to be most prevalent in
different social categories: young adults (aged 18–29 years); older adults; people with a
physical or mental health condition; people with low income; and people with different
marital statuses (single, separated, widowed, or divorced [7]).
Loneliness has been found to have a wide range of negative impacts on an individual’s
psychological and physical health [7], and is often wrongly conflated with social isolation;
research identifies that loneliness can occur in the presence of others.
Fox [8] found that loneliness was a predictor for social media use and an aggravating
factor for those at risk of health, especially regarding body image and eating disorders
such as anorexia or bulimia. Çivitci and Çivitci [9] found that loneliness was negatively
associated with life satisfaction and self-esteem. Çiçek [10] also showed that self-esteem
had a mediating role in the association between loneliness and psychological well-being in
young adults.
Neff and Vonk [11] identified that self-esteem (an evaluation of adequacy that is de-
rived from positive self-appraisals and favorable comparisons with others) was consistently
correlated with higher body satisfaction. According to Albertson et al. [12], the prevalence
of body dissatisfaction among teenagers and young women in Western European countries
is widespread, with the majority reporting negative thoughts and feelings about their
weight and body shape.
Hardit and Hannum [13] showed that the main predictors of body dissatisfaction were
parental influence, peer influence, and mass media. The authors claimed the last factor
was the most significant. Zinovyeva et al. [14] identified that young people with body
dissatisfaction tended to narrow their social contacts or even isolated themselves.
Shwartz [15] identified that self-esteem was negatively related to the use of SNSs,
suggesting that the more frequently people went on SNSs, the lower their self-esteem. Chen
and Qin [16] concluded that decreasing loneliness and increasing self-esteem should be
applied in interventions to reduce social anxiety among teenagers.
People with low self-esteem were proven to be more prone to using SNSs. The consequences
are self-isolation; neglecting of personal relationships; increasing risk of psychological prob-
lems, such as depression, loneliness, dietary and sleep disturbances; and dissatisfaction
with personal and social relationships [17].
The impact of SNSs on mental health has been frequently described, and sometimes
reflected in opposing findings. For example, O’Keeffe and Clarke-Pearson [18] pointed to
the “Facebook depression”, whereas Jelenchick [19] showed that the use of SNSs in clinical
settings had an extremely important positive impact on patients’ recovery, especially in
mental health problems, on the condition that the person was not addicted to SNSs.
The aims of the present study were to assess the presence of body-image satisfaction,
self-esteem, and loneliness among the young users of SNSs and to identify the relationship
between them. Comparative analysis between different categories was also assessed in
order draw conclusions considering gender, marital status, financial income, age, or dieting.
Int. J. Environ. Res. Public Health 2022, 19, 5064 3 of 14

2. Materials and Methods

2.1. Participants
The study was conducted in September–November 2021 in two medical universities
in Romania. The questionnaires were distributed online to a total of 540 medical students
enrolled across all academic years of study. Participants were informed about the purpose
of the study, about the fact that they could withdraw from the study whenever they
wanted, without consequences, and about the confidentiality of data. No incentive was
given to respondents. The inclusion criteria were that participants had to be students
enrolled in one of the universities, and filling out the questionnaire before the deadline.
The exclusion criteria were questionnaires incomplete or submitted after the deadline.
Finally, 427 questionnaires were included in the research. Figure 1 provides details on the
response rate.

Figure 1. Study profile.

2.2. Data Collection

The online questionnaire was created using the Google Forms application (Alphabet,
Mountain View, CA, USA) and was developed to obtain detailed information about stu-
dents’ perceptions of body image and the influence of social media, and to self-evaluate
body image, appearance, self-esteem and level of loneliness.
The first part of the questionnaire gathered socio-demographic, academic and anthro-
pometric information (such as age, gender, marital status, home environment, year of study,
members of the household, monthly financial income, weight status and self-evaluation of
weight status).
The second part questioned respondents’ satisfaction about body image and physical,
mental and social health; the level of satisfaction regarding perceived emotional support
from family and friends; and self-assessments of depression and stress levels. Self-assessed
items were specially constructed for this questionnaire after a literature review. Responses
were rated on a 5-point Likert scale, except for the item on body image satisfaction, which
was assessed using a 10-point Likert scale.
The third part of the survey collected information about the use of social media
(such as Facebook, Instagram, WhatsApp and YouTube), the main reason for using these
applications, the average time spent on these networks a day, and the level of interest shown
by users in the number of positive or negative reviews they received for the content posted.
Int. J. Environ. Res. Public Health 2022, 19, 5064 4 of 14

The final part of the questionnaire included three psychological tools in order to assess
appearance and body image, self-esteem and loneliness:
• Body Esteem Scale for Adolescents and Adults [20] was developed by Mendelson et al.
in 2001 and comprises 23 items. This instrument is a self-report tool that includes
3 subscales: private general feelings about appearance, weight satisfaction, and evalu-
ations attributed to others about one’s body and appearance. The respondents needed
to indicate their degree of agreement on a 5-point Likert scale ranging from 0 (never)
to 4 (always). The scores for each subscale and the total were computed by simple
addition. A higher BES score indicates a higher level of body esteem.
• Rosenberg Self-Esteem Scale [21] consists of 10 items and is a self-report instrument
for evaluating individual self-esteem. RSES was scored using four response choices,
ranging from strongly agree to strongly disagree.
• UCLA Loneliness Scale (ULS-8) contains the 8 items selected from the revised UCLA
Loneliness Scale of Hays and DiMatteo [22]. The answers are scored on a 4-point Likert
scale from 1 (never) to 4 (always). The ULS-8 is a commonly used tool developed to
measure one’s subjective feelings of loneliness, and feelings of social isolation.

2.3. Statistical Analysis

The statistical analyses were performed using IBM Statistical Package for Social Sci-
ences (SPSS) for Windows, version 24 (SPSS Inc., Chicago, IL, USA). Results for descriptive
statistics are expressed as means and standard deviations (SD).
Body mass index (BMI) was computed and used to classify the participants into nor-
mal, underweight, and overweight/obese groups according to WHO guidelines, using
standards for the European population: a BMI < 18.5 kg/m2 was categorized as under-
weight, 18.5–24.9 kg/m2 as normal weight, 25.0–29.9 kg/m2 as pre-obese, 30–34.9 kg/m2
as obese class I, 35.0–39.9 kg/m2 as obese class II, and ≥40 kg/m2 as obese class III [23].
The normality of data distribution was tested -using the Kolmogorov–Smirnoff test.
Given the fact that all data are not normally distributed, a bivariate analysis was performed
and non-parametric tests were applied. To assess comparative results considering gender,
origin environment and use of social media, the Mann–Whitney test was performed.
Comparative results considering marital status, study university, type of housing,
members of the household, average monthly financial income, and weight status were
assessed using the Kruskal–Wallis H test to determine if there were statistically significant
differences between more than two groups of an independent variable on a continuous or
ordinal dependent variable.
Multiple linear regression analyses were performed to investigate possible effects of
different variables on the BESAA, RSES and ULS-8 scores of students. Only those variables
that attained significance in the correlation analysis were considered in the regression
analyses.
The Spearman correlation was used to test the relationship between variables. A
p-value < 0.05 was considered statistically significant.

2.4. Ethical Approval

The study was approved by the Ethical Committee of the Faculty of Medicine at the
University of Oradea, Romania, with the registration No. CFMF01/30.04.2021.

3. Results
3.1. Socio-Demographic, Anthropometric and Academic Data
Sociodemographic data were gathered, together with financial status, environment
characteristics, and household-related information.
The students were enrolled in all years of study (1 to 6), and aged M = 21.62 ± 2.37
(with a minimum of 18 and a maximum of 30 years old). Most students were female
(82.40%, n = 352) and more than half came from urban areas (71.70%, n = 306).
Int. J. Environ. Res. Public Health 2022, 19, 5064 5 of 14

Body mass index (BMI) was calculated, conforming to WHO guidelines, and we
identified that 63% of students had a normal weight.
Students were asked if they practiced physical activity in order to maintain their
weight or to lose weight. A large majority of students declared that they exercised to
lose weight or to prevent weight gain (80.6%, n = 344). Similarly, students were asked to
self-rate their level of satisfaction with their weight status. Detailed information about
socio-demographic and anthropometric data is presented in Table 1.

Table 1. Socio-demographic and anthropometric data.

Socio-Demographic and Anthropometric Characteristics M ± S.D and % 1

Marital status
Single 200 (46.8%)
In a relationship 216 (50.6%)
Married 11 (2.6%)
Accommodation during the academic year
Rent apartment 224 (52.5%)
Student dorm 96 (22.5%)
Parental home (with parents) 84 (19.7%)
with family (partner/husband/children) 22 (5.2%)
Co-habitants
Single 87 (20.4%)
Colleagues/friends 211 (49.4%)
Partner 54 (12.6%)
Parents 75 (17.6%)
Average monthly financial income
20–100 € 108 (25.3%)
100–200 € 148 (34.7%)
200–400 € 107 (25.1%)
>400 € 62 (14.5%)
Weight 64.12 ± 13.76
male 80.74 ± 14.83
female 60.58 ± 10.58
Body Mass Index 22.72 ± 3.94
male 25.32 ± 4.33
female 22.17 ± 3.62
Nutritional status (WHO)
Underweight 48 (11.2%)
Normal weight 271 (63.5%)
Overweight 86 (20.1%)
Obese class I 19 (4.4%)
Obese class II 3 (0.7%)
Self-assessment of weight status
Underweight 34 (8.0%)
Almost at a suitable weight 280 (65.6%)
Slightly overweight 93 (21.8%)
Very overweight 20 (4.7%)
1 Means and standard deviations (M ± D), frequency and percentages (%).

3.2. Satisfaction with Health-Status and Relationship with Family and Friends
The results indicated that most of the students had to rate themselves on a scale
from 1 (extremely unsatisfied) to 10 (extremely satisfied) regarding their body image
(M = 7.21 ± 1.87). Respondents were also asked to self-rate their level of depression and
Int. J. Environ. Res. Public Health 2022, 19, 5064 6 of 14

stress, and to evaluate the emotional support offered by family and friends. The results
showed that students did not feel depressed (M = 2.42 ± 1.14), but instead felt a higher
level of stress (M = 3.43 ± 1.13). Other detailed results are presented in Table 2.

Table 2. Self-rated items regarding satisfaction with health-related status 1 .

How Satisfied Are You with Your 1 2 3 4 5 M ± SD

physical condition 19, (4.4) 73, (17.1) 154, (36.1) 156, (36.5) 25, (5.9) 3.22 ± 0.94
mental state 33, (7.7) 69, (16.2) 127, (29.7) 165, (38.6) 33, (7.7) 3.22 ± 1.05
social relationships 17, (4.0) 45, (10.5) 104, (24.4) 191, (44.7) 70, (16.4) 3.59 ± 1.01
emotional support received from family 20, (4.7) 30, (7.0) 75, (17.6) 127, (29.7) 175, (41.1) 3.95 ± 1.13
emotional support received from your friends 11, (2.6) 24, (5.6) 105, (24.6) 187, (43.8) 100, (23.4) 3.80 ± 0.94
1 Number of answers (N) and percentage (%), means and standard deviations (M ± SD).

3.3. Use of Social Media

On average, students spent 3.38 ± 0.80 h on social media. Respondents were asked to
indicate which SNS they usually used. The results showed that, of the six social networks,
YouTube (98.8%, n = 422), WhatsApp (98.4%, n = 420), Facebook (93.2%, n = 398) and
Instagram (88.1%, n = 376) were the most frequently used, followed by Snapchat (48.5%,
n = 207) and TikTok (47.3%, n = 202).
The main reasons why students used these networks were primarily socialization
(49.0%, n = 209) and entertainment (31.1%, n = 133), and they were less used for solving
academic tasks (19.9%, N = 85).
Fewer than half of the students (47.5%, n = 203) compared themselves to others
when viewing different profiles, and they were quite uninterested in the number of likes
(M = 2.70 ± 3.00) or dislikes (M = 2.19 ± 2.00) for their posts.

3.4. Body Esteem Scale for Adolescents and Adults (BESAA)

The Cronbach alpha score was 0.94 for the total scale, 0.92 for BES-Appearance, 0.92 for
BES-Weight and 0.68 for BES-Attribution. For BESSA subscales we obtained the following
results:
• Appearance (BES-Appearance)—M = 33.46 ± 8.55,
• Weight Concern (BES-Weight)—M = 25.92 ± 7.97,
• Attribution (BES-Attribution)—M = 23.13 ± 3.27.
The results proved that respondents had a high level of body esteem. The total BES
score was, on average, M = 82.52 ± 17.85, and scores ranged from 38 (0.7%, N = 3) to
117 (0.5%, N = 2). No significant differences in terms of participants’ gender were found.
Table 3 presents the results for the subscales.

Table 3. Gender differences for the BESSA Scale 1 .

Subscales Men Women

BES-Appearance 34.53 ± 8.62 33.23 ± 8.53

BES-Weight 26.52 ± 7.32 25.79 ± 8.11
BES-Attribution 22.54 ± 3.82 23.26 + 3.13
1 Means and standard deviations (M ± D).

A Mann–Whitney U test was conducted to determine if there were differences in

BESAA total score between participants who exercised to lose weight or to prevent weight
gain and those who did not. The BESSA total score was statistically significantly higher
in students who did not perform exercise (Mdn = 94.00) than in students who practiced
physical activity (Mdn = 81.00), U = 8962.0, z = −5.267, p < 0.01).
The comparative analysis also showed that there were significant differences in the
BESAA score for the variable that refers to the self-assessment of satisfaction with body
Int. J. Environ. Res. Public Health 2022, 19, 5064 7 of 14

image (p < 0.001, U = 2010.50, z = −11.367); that is, those who self-rated as having lower
satisfaction with their own body (Mdn = 58.00) obtained a lower score in the body esteem
scale compared to those who estimated a higher satisfaction with their own body (between
points 6 and 10 on the Likert scale) (Mdn = 88.50).
A Kruskal–Wallis H test was conducted to determine if there were differences in total
BESAA score between groups that differed in their nutritional status: the “underweight”
(n = 48), “normal weight” (n = 271), “overweight” (n = 86), “obese class I” (n = 19), and
“obese class II” (n = 3) groups. The mean ranks of BESAA scores were statistically sig-
nificantly different between groups, χ2 (4) = 67.697, p < 0.001. The analysis of the data
showed that there were differences in total BESAA score between groups that differed in
their weight status: the “underweight” (n = 48), “normal weight” (n = 271), “overweight”
(n = 86), “obese class I” (n = 19), and “obese class II” (n = 3) groups. Median BESSA scores
were statistically significantly different between the different levels of weight status group,
χ2 (4) = 67.697, p < 0.001.
A post hoc Mann–Whitney U test was conducted to determine which groups were
different from which other groups. This post hoc analysis revealed statistically significant
differences in BESAA score between the normal weight (Mdn = 88.00) and class I obesity
groups (Mdn = 55.00) (p < 0.001, U = 805.00, z = −5.009), and overweight (Mdn = 73.00)
and class II obesity groups (Mdn = 46.00) (p = 0.019, U = 26.00, z = −2.343). Similarly, the
median BESAA scores for underweight (Mdn = 93.50) and overweight groups (Mdn = 73.00)
(p < 0.001, U = 992.50, z = −4.974), and normal weight (Mdn = 88) and overweight groups
(Mdn = 73) (p < 0.001, U = 6777.50, z = −5.848), were statistically significantly different.

3.5. Rosenberg Self-Esteem Scale

For the present study, the Cronbach alpha score was 0.885.
Global self-esteem scores as measured with the RSES ranged from 13 to 27 (M = 22.30 ± 2.48).
A Mann–Whitney U test was conducted to determine if there were differences in RSES
total score between males and females. We identified that the RSES total score was statis-
tically significantly higher in male (Mdn = 21.00) than in female students (Mdn = 20.00),
U = 10740.5, z = −2.557, p = 0.01).
The comparative analysis also showed that there were significant differences in the
RSES score for the variable that refers to the self-assessment of satisfaction with body image
(p < 0.003, U = 10075.00, z = −2.990); that is, that those who estimated lower satisfaction
with their own body (Mdn = 20.00) obtained a lower score of self-esteem compared to those
who estimated a higher satisfaction with their own body (Mdn = 21.00).

3.6. Loneliness Scale (ULS-8 Short Form)

The scale had good internal consistency, as determined by a Cronbach’s alpha of 0.882.
The total score for the Loneliness scale was M = 15.78 ± 4.58, and scores ranged from
8 (3.3%, n = 14) to 30 (0.2%, n = 1). Almost half of the students (45.2%, n = 1933) were found
to have a moderate to high level of loneliness. The detailed results are presented in Table 4.

Table 4. Results for the ULS-8 short form scale.

Loneliness Scale N (%) 1

Low levels of loneliness 141 (33.0%)

Normal to moderate loneliness 193 (45.2%)
Moderate to high loneliness 80 (18.7%)
High levels of loneliness 13 (3.0%)
1 Number of answers (N) and percentage (%).

The Kruskal–Wallis H test revealed that there were statistically significant differences
in the total Loneliness scale score between groups with different marital status: the “single”
(n = 200), “in a relationship” (n = 216) and “married” (n = 11) groups; χ2 (2) = 9.046, p = 0.011.
Int. J. Environ. Res. Public Health 2022, 19, 5064 8 of 14

The Mann–Whitney U post hoc analysis (p = 0.009, U = 18398.50, z = −2.619) showed that
people who were in a relationship (Mdn = 15.00) had a lower level of loneliness than single
people (Mdn = 16.00). No gender differences were identified.
Comparative analysis showed that men (Mdn = 2.00) felt less depressed (p < 0.001,
U = 9719.50, z = −3.708) and less stressed (p = 0.002, U = 10244.50, z = −3.150, Mdn = 3)
than women (Mdn = 3, Mdn = 4). Furthermore, the results of the Mann–Whitney test
(U = 11013.00, z = −2.362, p = 0.018) showed that men (Mdn = 4) perceived themselves to
be in a better state of mental health than women (Mdn = 3).
Comparative analysis showed that students who exercised in order to lose weight
(p < 0.001, U = 8962.00, z = −5.267) had a lower body esteem score (Mdn = 81) than those
who did not exercise (Mdn = 94). Similarly, students who exercised (p < 0.001, U = 11017.50,
z = −3.405) had a lower score on the physical health satisfaction scale (Mdn = 3) than those
who did not exercise in order to lose weight (Mdn = 4).
Our results showed that there was a positive correlation between the total score of
BESAA and the use of social networks. Thus, we identified that the more time the students
spend on TikTok (r = 0.15, p = 0.002) or Snapchat (r = 0.12, p = 0.01), the greater their body
esteem. Similarly, the use of Snapchat is strongly positively correlated with the RSES score,
so the more the students spent time on Snapchat, the higher their self-esteem (r = 0.12,
p = 0.008).
A strong negative correlation was identified between the total score of BESAA and
weight status, meaning the higher the student’s BMI, the lower the body esteem score
(r = −0.37, p < 0.001). Weight status was negatively correlated with the use of TikTok; thus,
the higher the BMI, the less students will use TikTok (r = −0.11, p = 0.02).
Age was found to be an important factor. The older the students, the lower the level
of loneliness (r = −0.11, p = 0.01). Similarly, the older the students, the lower the level of
depression (r = 0.10, p = 0.02). Moreover, the older the students, the lower the number of
hours a day spent on social networks (r = −0.24, p < 0.001).
A positive correlation was identified between the total score of RSES and financial
income; that is, the higher the income, the higher the self-esteem (r = 0.11, p = 0.01).
Additionally, the results show that, the more income students have per month, the more
likely they are to use YouTube more often (r = 0.09, p = 0.04). Details regarding the significant
correlations are presented in Table 5.

Table 5. Correlation analysis results.

Items BESAA RSES USL-8

r = 0.551, r = 0.145, r = −0.179,

Satisfaction with the body image
p = 0.000 ** p = 0.003 ** p = 0.000 **
r = −0.364, r = −0.366, r = 0.523,
Feeling depressed
p = 0.000 ** p = 0.001 ** p = 0.000 **
r = −0.355, r = −0.323, r = 0.400,
Feeling stressed
p = 0.000 ** p = 0.000 ** p = 0.000 **
What is the number of hours you
spend on social media or messaging r = −0.102, r = −0.117, no
sites, such as Facebook, Twitter, and p = 0.035 * p = 0.015 * correlation
WhatsApp?
r = 0.232, r = −0.409,
RSES 1
p = 0.000 ** p = 0.030 **
r = −0.366, r = −0.409,
ULS-8 1
p = 0.000 ** p = 0.030 **
* p < 0.05; ** p < 0.001.

3.7. Regression Analysis

Multiple regression was run to predict body esteem from satisfaction with body image,
use of TikTok, levels of stress, and loneliness. The multiple regression model statistically
Int. J. Environ. Res. Public Health 2022, 19, 5064 9 of 14

significantly predicted body esteem, F(4,422) = 93.704, p < 0.0001, adj. R2 = 0.46. All four
variables added statistically significantly to the prediction, p < 0.05.
Findings from the regression analysis for self-esteem indicate that levels of stress
and depression, financial income and loneliness emerged as significant predictors for
this variable. The multiple regression model indicated a small effect size for self-esteem,
F(4,421) = 24.102, p < 0.0001, adj. R2 = 0.17. All three variables added statistically signifi-
cantly to the prediction, p < 0.05.
Multiple regression was conducted to predict loneliness from levels of stress, body
image and self-esteem. The regression model indicated a small effect size for loneliness
F(3,423) = 54.075, p < 0.0001, adj. R2 = 0.27. All three variables added statistically signifi-
cantly to the prediction, p < 0.05.
For all of these analyses, linearity was identified as assessed by partial regression plots
and a plot of studentized residuals against the predicted values. Homoscedasticity was
also evident, as assessed by visual inspection of a plot of studentized residuals versus
unstandardized predicted values. There was no evidence of multicollinearity, as assessed
by tolerance values greater than 0.1. The assumption of normality was met, as assessed by
a Q-Q Plot.
Regression coefficients and standard errors for these analyses are detailed in Table 6.

Table 6. Regression coefficients and standard errors.

95% CI for B Collinearity Statistics

Independent Variables SE B
B LL UL β R2 ∆R 2 TI VIF

Model 0.47 0.46

Constant 54.599 44.778 64.419 4.996
How satisfied are you with your body image? 24.262 20.871 27.653 1.725 0.512 0.946 1.057
BESAA
How stressed do you feel? −2.909 −4.101 −1.716 0.607 −0.186 0.837 1.194
ULS-8 −0.813 −1.112 −0.515 0.152 −0.209 0.826 1.211
Use of TikTok 4.174 1.680 6.668 1.269 0.117 0.994 1.006
RSES Model 0.17 0.16
Constant 24.086 23.207 24.965 0.447
How stressed do you feel? −0.284 −0.522 −0.045 0.121 −0.130 0.630 1.587
ULS-8 −0.133 −0.189 −0.077 0.028 −0.245 0.711 1.407
How depressed do you feel? −0.291 −0.550 −0.032 0.132 −0.133 0.534 1.873
ULS-8 Model 0.27 0.27
Constant 27.140 22.975 31.305 2.119
How stressed do you feel? 0.895 0.533 1.257 0.184 0.222 0.816 1.226
RSES −0.439 −0.598 −0.280 0.081 −0.238 0.890 1.124
BESAA −0.067 −0.089 −0.044 0.011 −0.260 0.852 1.174
Model = “Enter” method in SPSS Statistics. B = unstandardized regression coefficient; CI = confidence interval;
LL = lower limit; UL = upper limit; SE B = standard error of the coefficient; β = standardized coefficient;
R2 = coefficient of determination; ∆R 2 = adjusted R 2 ; TI = tolerance statistic; VIF = variance inflation factor.

4. Discussion
The present study investigated the presence of loneliness, self-esteem and body-
esteem among students, and also identified the use of SNSs. Our study collected socio-
demographic data together with self-rated satisfaction with physical and psychological
health. The analysis of anthropometric data showed that 63% of students had a normal
weight, and 80.6% exercised to lose weight or to prevent weight gain. We identified that
students did not self-rate as being depressed but stressed, and the comparative analysis
showed that men self-rated as being less depressed and less stressed, and in a better state
of mental health, than women. Our results are congruent with Ljungberg et al. [24] and
Iorga et al. [25], who conducted a study on students, and identified that freshmen are more
depressed, whereas seniors are more stressed.
We identified that the most-used social networks were YouTube (98.8%), WhatsApp
(98.4%), Facebook (93.2%) and Instagram (88.1%), and less than half of the students declared
Int. J. Environ. Res. Public Health 2022, 19, 5064 10 of 14

that they use Snapchat (48.5%) or TikTok (47.3%). The purpose of using SNSs was for
socialization and entertainment, and less than one-fifth declared that they used social
networks for discussion or solving academic tasks. Some studies from the literature
showed that the most dangerous social media were Instagram, followed by Facebook and
Twitter, due to the increasing number of posts edited and polished images [26].
Our study showed that a large majority of students (80.6%) dieted in order to main-
tain or reduce their weight. When comparing dieting and non-dieting respondents, we
identified that there were significant differences between the two groups. Our results are in
congruency with those obtained by Peternel and Sujoldžić [27]. The researchers found that
students who were dieting reported significantly lower scores for self-esteem, lower levels
for life satisfaction, lower body-image satisfaction, a higher rate of stress and a higher body
mass index when compared to non-dieters. Tiggemann and Slater [28] showed that SNS use
was correlated with internalization, body surveillance, negative body esteem, and dieting.
We found that the higher the financial income, the higher the self-esteem. Additionally,
the results show that the more income students had per month, the more likely they were to
use YouTube more often. A study conducted by Peternel and Sujoldžić [27] confirmed that
female respondents with low socioeconomic status were more prone to engage in dieting.
We found that participants who engaged in physical activity in order to lose weight or
to prevent weight gain obtained a lower score for BESSA than students who declared that
they did not undertake physical activity for the mentioned purpose.
The results proved that respondents had a higher level of body esteem with no gender
differences. Our results are in opposition to those identified among female students but
at a younger age. For example, Perloff [29] showed that SNS use can be detrimental to
female teenagers’ body image because SNSs increase the negative impact of social media
comparison more than traditional media. Some other studies identified that appearance
comparisons on Facebook have a strongly negative impact on body esteem, but only on
European girls and not in Asian girls. Therefore, many studies concluded that, at a younger
age, the impact of images provided by SNSs will lead to comparisons, resulting in lower
body esteem [30,31].
Kim and Kim [32] identified that female subjects were more dissatisfied with their
body shape compared to men. Furthermore, the authors showed that men had higher
levels of self-esteem. Moreover, a negative significant relation between BMI and self-esteem
in women showed that the higher the rates of self-esteem among female respondents, the
lower their BMI.
We identified that RSES analysis showed that the self-esteem total score was signif-
icantly higher in men than in women. Additionally, the results showed that there were
significant differences in the RSES scores in the variable that refers to the self-assessment
of satisfaction with body image; that is, those who estimated lower satisfaction with their
own body obtained a lower score of self-esteem. Our findings are congruent with previ-
ous findings focusing on young SMS users. Social media use generates anxiety in adult
women [33–35], and has been proven to have negative effects on body image outcomes,
such as body esteem [11,14], body dissatisfaction [13] and body image [8].
Almost half of the students (45.2%, N = 1933) proved to have a moderate to high level
of loneliness. As expected, we found that young adults who were in a relationship obtained
a lower level of loneliness than single people.
Age was found to be an important factor. Our study showed that the younger the user,
the higher the scores for loneliness and depression, and the greater the number of hours
spent on SNSs.
A study by Donnelly and Kuss [36] demonstrated that Instagram use and SNS addic-
tion (where SNS addiction was defined by Schou Andreassen and Pallesen as “being overly
concerned about SNSs, to be driven by a strong motivation to log on to or use SNSs, and to
devote so much time and effort to SNSs that it impairs other social activities, studies/job,
interpersonal relationships, and/or psychological health and well-being”) were significant
Int. J. Environ. Res. Public Health 2022, 19, 5064 11 of 14

predictors of depression [37]. The authors found no such relationship between Facebook,
Twitter or Snapchat and SNS addiction or depression [36].
The analysis of the present data showed that, on average, students spent 3.38 ± 0.80 h
per day using SNSs. The results are congruent with those presented in different articles.
For example, Sampasa-Kanyinga and Lewis [38] showed that more than a quarter of the
investigated students reported using SNSs for more than two hours every day. Their
study identified that a daily use of more than two hours was correlated with a poor self-
rating of mental health, high levels of psychological distress, and even suicidal ideation.
The authors also showed that students with poor mental health were found to be more
frequent users of SNS. Health status was found to be one of the most important predictors
of loneliness, followed by social connectedness and, with much lower weights, lifestyle
and socio-demographic factors [39].
Our results showed a significant correlation between the number of hours per day
of using SNS and loneliness. The results presented by the scientific literature are contra-
dictory. Burke et al. [40] and Krasnova et al. [41] identified that there was a significant
correlation between SNS and loneliness, whereas Aparicio-Martinez [42] showed that
there was no significant correlation between loneliness and the use of checking platforms.
However, Gong et al. [17] conducted a study on medical students in China and identified
that more than half (53.42%) of the participants used SNSs for at least one hour per day.
The authors also proved that SNS addiction was positively related to depression, both
directly and indirectly.
The study identified that, the more time the students spent on TikTok or Snapchat,
the greater their body esteem level. Moreover, the use of Snapchat was strongly correlated
with the RSES score, so the more the students spent time on Snapchat, the higher their
self-esteem. The results are congruent with other studies. For example, in a literature
review that analyzed twenty research studies on the relationship between body image and
SNS use, Holland and Tiggemann [43] demonstrated that the overall time spent on SNSs is
related to indices of body image in some studies; however, a large number of studies did
not identify a negative impact of the time spent on SNSs on body-image satisfaction.
Al-Saggaf and Nielsen [44] concluded that more people who felt “lonely” on Facebook
disclosed Personal Information, Relationship Information and Address compared to people
who felt “connected”. The higher the student’s body mass index, the lower the body esteem
score. Weight status was found to be negatively correlated with the use of TikTok.
The strength of the present research is due to its number of respondents; thus, the
results generated by the study can be generalized for the population of young SNS users, es-
pecially medical students. The weak point of the research may be related to the unbalanced
number of female and male respondents, and the comparative results must be considered
with caution. The higher number of female students enrolled in medical studies is a general
limitation presented by all studies conducted on medical students worldwide. Moreover,
the results mirror the student population (especially medical students), so they must be
considered to not be generalizable. Future research should focus on the difference between
populations of young users with and without academic backgrounds.

Reflections and Planning

The use of SNSs is common among the young generation. The purposes for doing so
are diverse, such as socializing, solving academic tasks, or even using them for medical
or psychological issues. The authors suggest that the positive effects of SNS use are
strongly related to the absence of addiction and psychological problems; otherwise, the
more frequent the use, the stronger the vicious circle. The increasing number of hours
invested in the use of SNSs is strongly related to some psychological problems, but it is
sometimes difficult to clearly identify the process—does the number of hours determine
the dissatisfaction with body image, or does the low satisfaction with the body image
determine the self-isolation, loneliness and motivation to increase time spent on SNSs?
Int. J. Environ. Res. Public Health 2022, 19, 5064 12 of 14

Practical implications for body image intervention programs, also targeting the de-
crease in loneliness and increasing self-esteem among teenagers, can be drawn from the
findings of the present study.

5. Conclusions
The results of the present research proved the relationship between the use of SNSs
and the presence of loneliness, self-esteem and body-esteem, with gender differences. In
clinical settings, the use of SNSs should not be neglected due to their effective ability to
reach patients and to provide medical and psychological intervention. In academic settings,
psychologists and counselors must be aware of the impact of SNS use on psychological
health, and provide preventive measures in order to decrease the risks of negative impacts.
Due to the fact that age, gender, financial status and time spent on SNSs were found to be
important factors, psychological and clinical interventions must be targeted on these aspects.
Moreover, verifying addiction to SNSs may improve the psychological interventions among
young SNSs users.

Author Contributions: Conceptualization, L.M.P. and M.I.; methodology, L.M.P. and M.I.; for-
mal analysis, L.M.P., M.I. and R.I.; investigation, L.M.P. and M.I.; data curation, R.I. and M.I.;
writing—original draft preparation, L.M.P., M.I. and R.I.; writing—review and editing, L.M.P. and
M.I.; supervision, M.I. All authors equally contributed to the present research. All authors have read
and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki and approved by the Ethical Committee of Faculty of Medicine at the University of Oradea,
Romania, with the registration No. CFMF01/30.04.2021.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Conflicts of Interest: The authors declare no conflict of interest.

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